Upper GI cancer

Question 1

Some of associations of gastric Ca

Answer 1

Pernicous anaemia

Blood group A

H pylori

Nitrosamine exposure

Question 2

Borrman classification of gastic tumours

Answer 2

i) Polypoid
ii) Ex-cavating
iii) Ulcerating and raised
iv) Diffusely infiltrative

Question 3

Troiser’s sign

Answer 3

Virchow’s node (left supraclavicular)

Question 4

Kruckenberg tumour

Answer 4

gastric tumour spread to ovaries via transcoelomic route

Question 5

Stage of presentation of most gastric tumours

Answer 5

Mostly present late at locally advanced (inoperable) or mets

Question 6

Main ix for gastric Ca

Answer 6

Gastroscopy and multiple ulcer edge biopsies

Question 7

How to stage gastric Ca

Answer 7

Endoscopic USS helps identifying thickness

CT/MRI

Laproscopic staging (for locally advanced)

Question 8

Peritoneal washings use for gastric ca

Answer 8

cytology helps identify peritoneal mets

Question 9

Rx of gastic cancer

Answer 9

Partial gastrectomy (distal disease) or full (proximal)

+ Chemo (epirubicin, cisplatin and 5-fluorouracil)

Endoscopic mucosal resection (for early disease)

Targeted rx

Question 10

Targeted rx for gastric Ca

Answer 10

trastuzumab for HER2 + tumours

Question 11

Oesophageal ca RFs

Answer 11

Obesity/alcohol/smoking

Achalasia

Low vit A&C intake

Nitrosamine exposure

Reflux oesphagitis +/- Barrett’s

Question 12

Achalasia

Answer 12

failure of relaxation of smooth muscle

lower oesophageal spincter contracts

Question 13

Sites and types of oesophageal ca

Answer 13

20% upper (SCC)

50% middle

30 % lower (adenocarcinoma)

Question 14

Sx of oesophageal ca

Answer 14

dysphagia

wt loss

retrosternal chest pain

Question 15

Sx specific to upper 3rd oesophageal ca

Answer 15

Hoarseness

Cough

Question 16

Ix for oesophageal ca

Answer 16

Oesophageoscopy + biopsy +/- EUS (gold standard)

MRI/CT

Laproscopic if sig infradiaphragmatic spread

Question 17

Rx of oesophageal ca

Answer 17

If T1/2 pre-op chemo + radical oesophagectomy

Others Ts: Chemo/radio/stenting/laser for palliation

Question 18

Gall bladder/bile duct cancer cell type

Answer 18

adenocarcinoma

Question 19

RF for gallblader/bile duct ca

Answer 19

primary sclerosing cholangitis

Question 20

Rx of gallbladder/bile duct ca

Answer 20

Very poor prognosis

Radical surgery (rarely effective)

Palliative stenting/chemo

Question 21

Commonest liver tumour

Answer 21

Mets 90%

Question 22

Cancer mets to liver?

Answer 22

Breast

Bronchus

GI

Question 23

Hepatocellular carcinoma causes

Answer 23

HBV, HCV, cirrohsis

aflatoxin (from mold in soil)

Clonorchis sinensis (parasite)

anabolic steroids

Question 24

Rx of HCC

Answer 24

if<3cm, resect

Percutaneous ablation

Transplant

Sorefenib

Question 25

Cholangiocarcinoma causes

Answer 25

Flukes eg clonorchis

PSC

HBV, HCV

DM

Question 26

Haemangioma

Answer 26

benign liver tumour

dont requrie rx

dont bipsy

Question 27

Typical pt for pancreatic ca

Answer 27

male

above 60 yo

Question 28

Genetics of pancreatics ca

Answer 28

95% have KRAS2 gene mutation

Question 29

Cell type of pancreatic ca

Answer 29

Majority adenocarcinoma

Question 30

Head of pancreas ca sx

Answer 30

Painless obstructive jaundice

Question 31

Body and tail of pancreas ca sx

Answer 31

epigastric pain

radiates to back

relieves on leaning forward

Question 32

Bloods of pancreatic ca

Answer 32

cholestasis picture

CA19-9 raised

Question 33

Most accurate imaging for dx of pancreatic ca

Answer 33

Endoscopic sonography (EUS) better than CT/MRI

Question 34

Rx of pancreatic ca

Answer 34

Whipple’s (pancreato-duodenectomy) if fit with no mets

Palliative (stent insertion)